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Claims Associate - Workers Compensation (Med Only) - Remote

Sedgwick

Role overview

Qualifications

  • High School Diploma or GED required
  • Bachelor's degree from an accredited college or university preferred
  • One (1) year of general office experience or equivalent combination of education and experience required
  • Claims industry experience preferred

Responsibilities

  • Analyzes medical only claims to determine benefits due
  • Processes workers compensation claims determining compensability and benefits due
  • Communicates claim action/processing with claimant, client and appropriate medical contact
  • Maintains professional client relationships and performs other duties as assigned

Key facts

  • Remote from: Florida (USA)
  • Full time
  • Junior (1-2 years)
  • English

Hard skills

Benefits Administration Internal Documentation Workers' Compensation Profitable Growth

Other skills

  • Communication
  • Empathy
  • Accountability
  • Collaboration
  • Problem Solving
  • Analytical Thinking
  • Stress Management
  • Time Management

About the company

Sedgwick logo

Sedgwick

Insurance

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. The company provides a broad range of resources tailored to our clients’ specific needs in casualty, property, marine, benefits, brand protection and other lines. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 31,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing – one where caring counts. Join us! Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive. A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work. Great Place to Work® Top 100 Most Loved Workplace® Forbes Best-in-State Employer

Company details

Company typeLarge
IndustryInsurance
Company size10001

Links

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Job description

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies

Certified as a Great Place to Work®

Fortune Best Workplaces in Financial Services & Insurance

Claims Associate - Workers Compensation (Med Only) - Remote

Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands?   

  • Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations.  

  • Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.  

  • Enjoy flexibility and autonomy in your daily work, your location, and your career path.   

  • Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.  

​

ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.  

PRIMARY PURPOSE OF THE ROLE  To analyze medical only claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. 

ESSENTIAL RESPONSIBLITIES MAY INCLUDE

  • Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision.
  • Supports other claims representatives, examiners and leads with larger or more complex claims as necessary.
  • Processes workers compensation claims determining compensability and benefits due; monitors reserve accuracy, and files necessary documentation with state agency.
  • Communicates claim action/processing with claimant, client and appropriate medical contact.
  • Ensures claim files are properly documented and claims coding is correct.
  • May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims.
  • Maintains professional client relationships; Performs other duties as assigned; Supports the organization's quality program(s).

QUALIFICATIONS 

Education & Licensing: High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. 

Experience: One (1) year of general office experience or equivalent combination of education and experience required. Claims industry experience preferred.

Licensing / Jurisdiction Knowledge: 

TAKING CARE OF YOU  

  • Flexible work schedule.  

  • Referral incentive program.  

  • Opportunity to work in an agile environment. 

  • Career development and promotional growth opportunities.  

  • A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. 

WORK ENVIRONMENT REQUIREMENTS INCLUDE  
When applicable and appropriate, consideration will be given to reasonable accommodations. 

Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines 

Physical: Computer keyboarding, travel as required  

Auditory/Visual: Hearing, vision and talking

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

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MR

Marcus Rivera

Chief Revenue Officer

m.rivera@company.com
linkedin.com/in/marcusrivera
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